pain in the butt

my behind hurts all the time. well, that's not fair to say. there are periods of time where it doesn't hurt, but mostly any time i sit, or when i get up from sitting it hurts. the obvious explanation is that there's less padding, and that is partially the case, but there are some other factors too.

aPPARently...this is a common complaint for people that spent many years being very overweight and then lost weight. it's not just the lack of padding, but also that all the years of having so much extra fat around the tailbone made it protrude, and now that there is no longer all that tissue, the bone is still protruding and there's no tissue to surround it, so it's exposed. something like that. and that's about what it feels like.

in the car, we have a wedge pillow like this that seems to, for the most part, make it pretty painless but it doesn't work on my home seats. it sinks or something. i have to look into some other options...apparently me and many others, this website would have me believe. so at home, i end up sitting on my hip or one butt cheek to avoid the pressure on my butt. and at work, it's never really been a problem until more recently, so now i use a cheerful little pillow to sit on. overall, it pretty much sucks. i used to love sitting upright on my bed on a weekend afternoon catching up on TV and it just doesn't have the same luster when i have to watch said TV on one butt cheek to avoid searing pain. but the most aggravating part of the discomfort is the one i feel - intense but short - when i stand up...i guess from all the compression and then the subsequent release.

the other factor that i have to say definitely has an impact is the loose skin in that area. when i'm seated, so much extra skin bunches up between my lower back and my butt and that also presses down on the top of my tailbone...can you picture this? would you want to?

i'm told by my surgeon's office that although there is no cure for this problem, nor does the tailbone ever go back in from its protrusion, people only seem to complain about it while they're still in transition and not once they're done losing weight. i guess it could be they just adapt and stop complaining, or maybe they learn to only sit in ways that take the pressure off. 

can you believe this problem?

reflections, part 2

today, for the first time, i didn't recognize my own reflection as i walked by a window. it was a really exhilarating moment ... one of only a few i've had since this process started. let me be clear - it's not that i'm not full of joy and relief - i am, almost every day. but it's one of those things...though it feels surreal sometimes, most of the time, it just feels like my life. it's not without challenges, nor should it be. and it hasn't gone fast - i have felt every day of this past almost-year and it has been hard work, emotionally and physically, and an ever-evolving life. 

so when people ask me "can you believe that you've lost all this weight?," my answer is yes. when people ask if i can believe it's only been a year, my answer is yes. and when i look in the mirror, i most of the time don't feel tremendous waves of emotion when i see my reflection, which is in itself an improvement. i feel okay with what i see, and while i recognize the progress in broad strokes, i don't often experience a rush of pleasure or shock when i see my reflection. but today i did.

bottoms up

so i was cleared to try alcohol in advance of my sister's wedding last weekend. it's supposed to be a year from the surgery, but i asked for special dispensation about three weeks shy of the one year mark. dr. b and sophie (his PA) granted me permission, warning me to go slow and that i would get drunk fast. they suggested one drink. partly, it's because gastric bypass patients tend to have a lower tolerance for alcohol post-surgically. that's partially because we absorb ethanol at a faster rate because the tiny stomach dumps the alcohol directly into the jejunum which has a large surface and absorbs the alcohol quickly. also,  we a) weigh less and b)haven't had a drink in sooo long.

drinking presents challenges - no sugar, no carbonation. so there goes wine and champagne, my two drinks of choice before (really only sad to see champagne go...). so vodka seemed the answer. can't mix it with tonic or soda, or juice...diet snapple it is. so last wednesday night, i tried a half of a shot of vodka mixed with some diet snapple. i definitely got that initial taste of tipsiness on the fast side, but it didn't escalate quickly at all. i felt fine. and it was fun!

so for the festivities surrounding molly's wedding, i sipped vodka. i didn't have diet snapple handy, so i mixed it with a little crystal light and water one night (that was good!) and with water and fresh lemon juice the rest of the time. i actually think it's probably a good thing to mix it with water and lemon juice because it sort of goes down slower than something that tastes like candy. 

mitchell was a little nervous and watching what i drank pretty carefully, but overall, i enjoyed having a couple drinks, and i look forward to doing it again on appropriate occasions :) 

i didn't feel like i got particularly drunk, and it didn't make me want to eat a lot or the wrong things, which i'm very pleased about. i will be very sure, though, to manage my drinking habits...i am well aware that so many weight loss surgery patients experience cross - addiction and addiction transfer, and i have to be mindful about my susceptibility to that. if i find myself looking forward to a drink in the middle of the day, i have to be committed to getting off that train.

i also have to manage my tendency from long ago to want more and more of what's making me feel good (as in: pizza, lo mein, sandwiches, cigarettes, coffee, alcohol...can't i feel that way about the gym?) i need to get used to enjoying the feeling of being a little buzzed and not wanting to feed it with more alcohol that will make me uncomfortably, and perhaps dangerously, intoxicated. i guess i'll be working on it at the same time as i get used to tasting a little bit of something and having that be enough. they're more than a little connected.

image

(don't) eat your wheat(ies)

alright, so last week, with the help of my nutritionist adrienne, i decided to eliminate the following from my diet: yeast, wheat, gluten, flour. seems extreme, i know. 

over the last several months, i'd started to experiment with whole grain breads. then as i got more comfortable with trying them (even outside my own home!), i moved to whole wheat breads occasionally, when whole grain wasn't available. i found a "no white" bagel and test drove that. and i can not tell a lie... there were a few stray times when i tried white bread. like, challah roll on the table at the diner bread. you can see where this is going... i also tried pizza. true, there was also the whole wheat pizza from skinny pizza, a wonderful improvement to takeout, for sure. but here's the problem. every time i drove by that wonderful improvement, i wanted pizza. not so wonderful.

i noticed a similar phenomenon when i flew down to florida to be with my mother in law for a procedure she was having (she's fine). in the amazing terminal 5 at jfk, i needed to pick something up to bring on the plane. (no blue potato chips for this girl). i chose a hearty looking turkey sandwich on multi-grain bread. i ate it in three different sittings, and it was highly satisfying and delicious each time. i felt like i had hit the jackpot - here i was, sitting on plane in ONE seat, between strangers, armrests down, tray table down, out of my mind on xanax...okay, i digress...but the point was, i was being a NORMAL person, eating a sandwich and wrapping up the rest for later. who IS this person?

this person is ME. the same one who weighed almost 400 pounds a year ago. because the problem is that that night when it was time for dinner, i ordered another turkey sandwich, this time on whole wheat bread, and i ate the whole thing. did it weigh more than 6 ounces? probably not. but the fact of eating an entire turkey sandwich in one sitting scared me. when i woke up the next day, all i wanted was bread. it's that thing about carbs...we learn and relearn the same lessons over and over, don't we?

at the airport coming home, waiting for my delayed flight in the rain, anxious and tired, i ordered tortilla chips and spinach dip as my dinner. BAD SCENE. i knew right then, with every delicious bite, that i had gone down a bad road;  i had been on a bad jag and that it needed to end. almost the way you might look at confession, i saw adrienne and i told her everything. and here's what she said. she said "this is a whole banquet room you don't need to go into, you just don't need to go there. this is a dark and dangerous road." she also said "if you know something about yourself, just accept it."

that struck me. on one hand, i think she's so right. i agonized for the first couple post-op months trying to understand why some weight loss surgery patients swore off carbs and others thought it was okay...i needed to be told what to do, and there was so much guidance out there that it netted out at nothing in a way, making me feel really lost and on my own. what i arrived at eventually was that the people who swore carbs off generally felt they slowed their weight loss, but also that they were trigger foods and that they were, habitually, too close to what made them fat in the first place. i figured as long as i could monitor that, i should go forth and eat carbs responsibly. why? two reasons really, and maybe they're not that different.

1. i like carbs and wanted to eat them.

2. i fear extremity - i think i am afraid to say "i don't eat carbs" (though i know that's an oversimplification, as vegetables are carbs, etc) because if i say that, then it seems like a gimmick, like something with an inevitable failure date, like a diet that just begs you to cheat.

so while adrienne's directive to know myself and accept it feels good and simple on one hand, there's this other part of me that fights it...i want to be able to be moderate. i don't want to have to say that i don't or can't eat certain things...i want to believe i have enough control over myself to live in the gray area, or that at least i can work towards that as a goal.

then, i continued the discussion with carrie, my therapist. she shed an even different light on it...she said "how could you go through this process and not try pizza? you have to give yourself that experience, so now you did it and you're done." she also shared her own experience about eliminating bread in her own life because it makes her feel better, and it makes her lose weight. it's a choice. it's not that she CAN'T eat bread, it's that she's choosing not to. in some ways, THAT is the moderation...it's knowing that while you COULD eat something, for whatever reasons, you're not going to. 

although i've never experienced a "honeymoon period" in this process the way many people report, i guess in some ways, the honeymoon is over when fear doesn't stop you from eating certain things anymore. at first, i never would have dreamed of eating bread (especially white flour bread!) because i'd be afraid it would make me sick. when you know it won't, that's when the real work comes in. it can't be about fear anymore, now it has to be about strength. 

so for today, my strength is coming in the form of the decision NOT to eat my wheat(ies). and it's an evolution, as all of this is. as my old weight watchers leader said, "i don't know about tomorrow. i'm not there yet." but i have to say, today, it feels kind of awesome to walk by the bread aisle at the grocery store and just know that there's nothing for my there - that's not my aisle. it's freeing not to read every label, hoping to see a magical permutation of numbers that would allow me to have a piece of something...fiber, net carbs, sugars, etc. i just don't eat those things right now. period, the end. and on a side note, i haven't been feeling particularly hungry, i've been having a true sense of fullness almost all the time and i've lost 5 pounds in the last week.

another side note...i love how a trifecta of very strong women - nutritionist, therapist and weight watchers leader - are helping me to navigate these waters. if i were having a bat mitzvah again, i'd definitely be calling them up for a special candle :)

pleasant surprise

having nothing to wear is a good problem to have in this case, but it's a problem nonetheless. most mornings, i put on a few items and then immediately move them to the pile of donations. it's annoying because i feel like i just assessed each item recently and decided to keep it, and then it's too big the next week. like i said, good problem to have, i realize, but it is annoying. i'm down to one pair of jeans (these, which i love) and a bunch of size 14/16 cotton tops which seem to be working okay. although i'm pretty solidly in a size 14/16 on top, the bottom remains a bit of a challenge because i generally carry a lot of weight in my middle area, and i have a lot of loose skin there making matters worse. 

so i was pleasantly surprised when i decided to just try a pair of size 16 pants i got who knows how long ago. they fit! and these are not a lane bryant 16 or an avenue 16, these are a dress barn 16, which means they're not as "generously cut" as true plus size pants. sidebar - dress barn? i think i shopped there exactly once and bought these pants, so go figure (do they have good stuff? should i go there?)

for a while, i've been feeling like no matter how much i lose, i might really need plus size pants for quite a while. i felt that way when i couldn't close the size 18 pants i had hanging, and i felt that way about these 16's too, but now i'm seeing it might not be as slow as i thought. not a bad way to be wrong.

i love new but old clothes, especially when the sizes are moving in the right direction.

skin deep

one of the most common discussions post-weight loss surgery is skin. while skin's ability to "bounce back" largely depends on age and skin elasticity, there are two commonly accepted truths: it's better if you exercise to at least tone what's there, and that if you lose more than 100 lbs, you're going to need the skin removed, or at least you'll want it removed in procedures commonly known in the WLS community as "plastics."

some people with large amounts of loose skin get infections and have health-related issues because of it, though sadly not very many, otherwise maybe insurance would be a better bet for coverage. since my insurance didn't even cover my gastric bypass (but of course they'll cover cancer, diabetes, heart disease and everything else that comes from obesity, but i digress...) i doubt they'll cover what actually IS more cosmetic (i'm sorry, but gastric bypass surgery is NOT cosmetic. okay i'm digressing again).

because i feel comfortable with you, my readers, i'll share what my arms look like right now. it's not pretty and you can even see the volume and looseness through thin shirts and sweaters when i move my arm quickly.

 

but the way i try to see it is that it's better than if there was fat filling the skin. my two biggest problem areas with skin are really my arms and my stomach, very common places. the procedures that would probably be done (once i'm totally done losing weight, have maintained the loss for at least a year and won the lottery) are an abdominoplasty (tummy tuck), a mastopexy (breast lift), and a brachipoplasty (arm lift).

in the picture, i can actually see the contour of a thinner arm on top, which is encouraging, like you could just lop off that whole bottom section and my arm would be great. no amount of toning at the gym (where this picture was taken) will fix what's on the bottom, but that's a worry for a later time.

leftovers

so you know how the moment where i have to stop eating is still hard for me sometimes? i had a little revelation this morning...i was having breakfast - turkey bacon, 2 egg whites and half a piece of american cheese on a slice of multi-grain bread. i ate the turkey bacon first (protein first, always) and then i had a bite or two left of the sandwich. i was full. not too full, just done. normally, i have that feeling where i weighed it, and the whole thing was 5 ounces, so why can't i have it? it's mine. 

this morning that wasn't really the feeling, and i felt like that was progress. i felt happy to feel done after a small, reasonable breakfast...the gift of early satiety that the surgery is best loved for. what i felt, though, was more just anxiety about how i'd account for the piece that was left over...if my breakfast was 248 calories and 23g of protein (which it was), then what do i do about the piece i was leaving over? on weight watchers, i would have just removed a point from the grand total number of points, and although i could figure that maybe 30 calories and 3 grams of protein could be shaved off, then how do i denote that in sparkpeople where i calculate my calories and protein? although the 30 or so saved calories doesn't matter much one way or the other, the protein is important to account for accurately. 

as i write this out, i realize this is probably one of two things, if not both: either a mind game because i'm finding a way to cling to that one other piece, or my own hangup on perfection for perfection's sake. as i finish writing this, i felt hungry again for that last piece. i put it in my mouth, and then i spit it out. i wanted to throw that last piece out...needed to. for principle, for progress, for peace of mind. it's in the garbage. 


just also realized a totally separate thought...i think in this instance, the bread acted as a stopper (which it can do, particularly when not toasted which this wasn't) and i actually think it falsely filled me. maybe bread shouldn't be a part of this meal, and i should just focus on the turkey bacon and egg whites.

changing my mind

part of my problem with food and eating has been scarcity mentality, which leads very obviously to binging. it's the feeling that "i might not always have access to this food so i better eat it now while i do." and that meant whether or not i was hungry, whether or not i wanted to be eating, whether or not i even liked what i was eating. i think in many ways it started as a kid because my mother was always concerned about my weight, so i felt watched...when she'd leave the house, it was time to eat! anything, everything, in large, sickening quantities, and fast because i never knew when she'd be back. sometimes, she'd be back much sooner than i expected to get something she forgot, and then the jig was up. i don't blame her...she was concerned, and with good reason. i know she often looks back and wonders what she did wrong, and although it's easy for everyone to play monday morning quarterback, she did what she thought was right, she did it out of love, and i don't blame her. (you hear that momma?)

but long after my mother was watching what i ate, it was the way i behaved. when i got my license, my main source of joy was not that i could cruise around with friends and be free (which i did, and i was), but that i'd have the shameless ability to get myself food - a lot of it. i could drive to a fast food restaurant and up to the drive-thru, not even having to get out of the car to order. i'd order so much that i'd pretend i was ordering it for a crew of people - pretending to the muffled voice on the other end of the speaker, pretending to myself. and then i'd go to another drive-thru and do the same. you don't get to be almost 400 lbs without habits like that...it's not just a sweet tooth that gets you there.

so even now, even when i can no longer physically binge because i've taken away that option, i have to be mindful of the behaviors that drove my binging, and the thought processes that were behind those behaviors - i had a gastric bypass, not a lobotomy. i have to watch the tendency to graze, which i've come to see as a long, slow binge. i have to watch my tendency to want to eat just for eating's sake, which i thought would fade away but hasn't yet...that moment when i know it's enough, but it's still hard to let go of that one ounce that i know could be mine...and i have to be mindful of my mind's ability to play tricks on me...that a whole bag of popcorn could be only 3 or 4 ounces, which i'm allowed to eat, volume-wise, but that that doesn't mean that i should eat the whole bag of popcorn, behavior-wise.

a lot of times, the old behavior comes from a good place, from wanting to do the right thing. it has always come from a good place - it was to make myself happy, comfortable and soothed. if we had a way to give that to ourselves or anyone else we loved, wouldn't we want to? it's the kind of love that hurts on the back-end.

here's an example of today's good intentions leading to yesterday's behavior... i want desperately to be off of artificial sweeteners, but i can't have sugar and i want to be able to eat sweet things once in a while. last week on my lovely farmers market outing, i discovered a fresh apple muffin that had no sugar ... it was sweetened only with apples and had oats and whole wheat flour, and was utterly delicious. upon realizing how much i liked it, and how it could totally replace junky snacks like this and this, my immediate thought was "so i should stock up on these every wednesday at the farmers market." 

as i thought through the plan, i realized quickly that part of what was so good about the muffin was that it was really soft and fresh, and that by the next day when i went to have the other half, it had already lost that, so two days or three days after buying it would be even less fresh...of course i explored that i could freeze them, refrigerate them, etc. but then it hit me - i should buy one on wednesday and have half of it and then save the other half in the fridge or freezer or give it to someone else to enjoy. and that's it. i don't have to eat it EVERY day. i don't have to STOCK UP. it can be something i have once in a while. and i can get to a place where my mind can change, and where that type of scarcity will be okay with me.

food for the soul

as i learn more and more about organic food and farming and our country's industrial food system, i become more and more impassioned about eating whole, healthy, natural foods, and so shopping at a farmers market, which was always appealing and feel-good to me, has become nourishing in a totally different and ever-evolving way. i feel like moving to the country and living and working in a way that honors the sun and the soil and the water and animals and plants and farm workers as well as the consumers and the society that supports it. but alas, there are billions of words written on those exact thoughts and feelings, and in some ways i take comfort in knowing there's a certain universality to those values and feelings. the best i can do is to live my non-country life in a way that honors those values, and so i've begun to do that in the very large majority of the way i shop and eat - farmers markets, whole foods, trader joe's, organic when possible, fresh and local almost always. see my ode to tomatoes from yesterday, which were in utter explosion mode at the farmers market today. of course there are a few straggling processed foods i still support - sweet and low (my main source of guilt and shame in life), sugar free foods, protein shakes and bars, etc. 

ANYWAY...i had an almost out-of-body happiness this morning at the farmers market near my office as i inhaled the sights, sounds and scents of a bustling market filled with gorgeous, fresh produce and dairy, the people who grow and pick and transport them, and a disparate collection of people who value the whole cycle. i was walking around smiling strangely, perusing all the items and deciding what i'd buy and from which stand. 

one of the things that's really lovely about having a very small stomach is that i don't need much food (sounds funny, doesn't it?), so i can buy really high quality foods in small quantities. this works out emotionally too, because i feel really good about buying the best food i can afford. one of the strange points made in one of the documentaries i've been watching (i think it was this one, though it could have been this one too, both of which should be on your queue immediately) is that americans spend much less on our food than other countries...which is sort of ridiculous since it's what we're putting in our bodies, and we only get one body. 

 

so i spent $12, and i got a real abundance of things to use over the next several days. i tried to buy some a little less ripe after confirming with the seller that they would ripen on the countertop...this way, i don't feel produce pressure immediately and can use them in waves, though all in the next couple days so i don't defeat the purpose of buying fresh and local. i got 2 beautiful green peppers and a white pepper (first time i've seen those!) which are supposed to be sweet, like red and yellow ones. i also got a bunch of radishes to dice up into salads, inspired by the healthy 8 from trader joe's. then i got a 1/4 pound of salad mix which i'm going to try adding to my lettuce-less shrimp and chicken salads, 2 teeny tiny plums, 2 donut peaches, an apple, a container of amazing looking cherry tomatoes in many colors, and a no sugar apple muffin...sweetened not with chemicals or sugar, but with apples and a touch of organic agave nectar. if it's good, and if i feel okay after eating a piece of it, it could be a great alternative to junky sugar free snacks that make me feel guilty (and sometimes gassy) because they're made of things that are not, or should not be, food.

the thing that made me smile the most was the sight of little babies, sleeping in strollers being walked around the farmers market. they're too young to make their own choices obviously, but the people making their choices for them seem to be doing it thoughtfully just by being at the market and not at the bodega or the grocery store around the corner, and they're doing something wonderful by bringing them there...even if they're sleeping, even if it's years before they know what arugula is or how to pronounce radicchio. it means something, even at their early age, to be there and be involved in the process. if you like this idea, read this inspiring interview. 


i'm hopeful that values about how and what we eat can sink in through a form of childhood osmosis, because it's something i really want to pass on to my own eventual children one day. the thing that leaves me wondering is why it didn't happen earlier on for me, someone who was lucky enough to have healthy-living parents with a sense of moderation and balance, who always worked hard at their own fitness and bodies...they did everything right in that regard. wow, that just became a downer. nah, not really a downer...it's all an evolution and i'm happy to be where i am, today.

bad medicine

the other day, a friend needed a recommendation for an orthopedist in the city and fast. i told him that i had one, but that he was a jerk on a personal level. he said he didn't care about that, and then he asked for the story and here it is:

about a year ago, i was having problems with my right hip which was just constantly hurting. as i often did, i assumed it was weight-related and figured it would get better when i lost weight so why seek medical attention? don't worry, this doesn't end badly, it really was weight related and nothing horrifying, but eventually the pain got bad enough that i figured i needed some relief and scheduled an appointment with an orthopedist i'd seen before. he took x-rays and determined that it was a little arthritis and prescribed an anti-inflammatory. because i was so used to doctors telling me i needed to lose weight, and because i was already scheduled for my surgery and armed with a plan, i felt the need to tell him right away that i knew it was probably weight-related and that i was going to be having the surgery, etc. i was so used to being on the defense in medical situations that i was happy to, for once, have a confident plan to lead the conversation with rather than “well i rejoined weight watchers and…” but in spite of my confident plan, this doctor managed to stun and shame me anyway. he was unmoved by my announcement of the surgery and my looking forward to it and instead pursued his own line of questioning.

doctor: so how long have you been this size?

me: well i've been in this general area for many years...since college i guess, but heavy in high school too.

doctor: wow.

me: yeah, so the surgery really feels like the right choice for me.

doctor: so what do you, just eat a lot?

me: um, yeah i guess. but its a little more complicated than that…
 

doctor: i mean, i can understand sometimes you just want to keep eating and (makes piggish noises and a shoveling motion with his hands to his mouth) but i mean, you have to just stop yourself.

me: (almost speechless) yeah i mean, like i said it's not as simple as what you're saying. i mean, i've done lots of reading and i'm in therapy and it’s a disorder even though many people don’t understand that, and --

doctor: okay well good seeing you. good luck, i'll see you again after you've finished the anti-inflammatory. take care.

when i told mitchell this story, he was infuriated and shocked, but i sadly wasn’t. i was used to this kind of treatment from doctors and other people alike, though admittedly, this time did seem particularly brutal. the truth is that many studies show that obese people receive the absolute worst medical care for two reasons – first, because doctors often blanketly assume that ailments are weight related (as do obese patients). though they often are, or certainly are exacerbated by weight, it sometimes causes patients and doctors alike to ignore symptoms that should be further explored because they’ve assumed the obvious, visible answer. and secondly, because some doctors, like some laypeople, are repulsed by obesity and see obese patients as lazy, lacking self-control and piggish. how can you care for someone in a respectful, responsible way when that’s what you think of them?

and the obvious other factor is that when people are treated this way and shamed by their doctors, it takes an awful lot to push through those feelings and drag yourself there when something hurts, especially when it’s something you know your weight affects. i didn't go back to the doctor after i finished my prescription. and my friend who didn't care that he was a jerk went and saw him and thought he was a jerk. shocker.